Download NS 210: Seminar 8 Nutritional Assessment in Disease Prevention

NS 210: Seminar 8
Nutritional Assessment in
Disease Prevention
How was everyone's week?
Overview
• The prominent role of diet and nutritional
status ins several leading causes of death for
North Americans give nutritional assessment
an important role to play in disease prevention
• Risk factors of Coronary Heart Disease
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Leading cause of death for North Americans
Are related to diet
Elevated serum total and LDL cholesterol
Hypertension
Diabetes
Ok Jeopardy Time
Coronary Heart Disease (CHD) is causally
associated with several risk factors
What are these Risk Factors?
Coronary Heart Disease
• Coronary Heart Disease (CHD)
– Leading cause of death in the US despite
>26% decline in CHD death rates since
1988
– Associated with several risk factors
• Elevated blood cholesterol
• High blood pressure
• Cigarette smoking
I will take HDL for 100 Alex
• What number do we want our High
Density Lipid (HDL) level to be to help
prevent onset on CHD?
Coronary Heart Disease (CHD) Risk
Factors
• Risk factors for CHD
– Positive risk factors
• Cigarette smoking
• Hypertension (blood pressure >140/90)
• Low HDL cholesterol <40
– Goals
» Women >55
» Men > 45
• Family history of premature CHD
• Age (men >45 yo, women >55 yo)
– Negative Risk Factors
• HDL Cholesterol >60
Heart Attack Warning Signs
• Heart attack warning signs
– Chest discomfort
– Discomfort in other areas of the upper body
• Arm, back, neck, jaw
– Shortens of breath
– Other signs
• Cold sweat, nausea, lightheadedness
Alex, I will take Cholesterol Levels for
100
• Having a cholesterol level of >200 is a
good or bad thing?
CHD Risk – Elevated Cholesterol
• CHD risk is directly related to serum
levels of total cholesterol and LDL
cholesterol
• CHD risk is inversely related to levels of
high HDL cholesterol
• National Cholesterol Education Program
(NCEP) desirable levels of total
cholesterol in adults
– <200mg/dL
Atherosclerosis
How is CHD Diagnosed?
• Dr. will diagnosis CHD based on:
– Your medical and family history
– Risk factors
– Results of a physical exam and diagnostic test
procedures
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EKG (Electrocardiogram)
Stress Testing
Echocardiography
Chest X-Ray
Blood tests
Electron-Beam Computed Technology
Coronary Angiography and Cardiac Catheterization
Ways to Help Treat CHD for 600
Hundred
• DAILY DOUBLE!!!
• What are some way to help treat CHD?
How is CHD Treated?
• Lifestyle Changes
– Reduce high blood pressure
– Reduce high cholesterol
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Follow a Heart Healthy Eating Plan
Therapeutic Lifestyle Changes
DASH Diet
Increased Physical Activity
Maintain a Healthy Weight
Smoking Cessation
Stress Reduction
Medications
Cardiac Rehab
Addressing High Cholesterol
• Two ways of addressing high cholesterol
levels
– Population based approach
– Patient based approach
• Population based approach
– Emphasizes dietary and lifestyle changes for
people to lower cholesterol levels in the entire
population
• Patient based approach
– Identification and treatment of individuals with
elevated cholesterol levels by physicians
Dietary Factors and Cholesterol
• Factors that can influence cholesterol and
lipoprotein levels
– Saturated fats
• Raise LDL cholesterol
– Unsaturated Fats
• Polyunsaturated Fats
– Lower LDL and HDL
• Monounsaturated Fats
– Lower LDL
– Maintain HDL cholesterol
CHD and Hypertension
• Hypertension is one of the most common risk factors
for cardiovascular disease and renal disease
– 1 in 4 Americans has hypertension or is taking
antihypertensive medications
– Systolic >120mm HG and diastolic >80mmg HG
increases risk for cardiovascular disease
• Most important risk factors for hypertension
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Sodium intake
Excessive energy consumption
Physical inactivity
ETOH consumption
Inadequate potassium intake
Nutrition Assessment in Disease
Prevention: Osteoporosis
• Osteoporosis
– Bone mineral content is decrease
– Resulting in great susceptibility to fracture
– Common fracture sites - pelvis vertebrae, hip, distal
forearm, humorous
• Peak bone mass
– Varies considerably among individuals because of
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Heredity
Sex
Race
Environmental factors
Nutritional Assessment in Disease
Prevention
• Osteoporosis
– Cost
• In 2005
– Osteoporosis-related fractures were responsible for an
estimated $19 billion in costs
• By 2025
– Experts predict that these costs will rise to
approximately $25.3 billion
http://www.nof.org/osteoporosis/diseasefacts.htm#gender
EER
• Adult males: EER=662
(9.53*AGE)+PA*(15.91*WT+539.6*HT
)
• • Adult females: EER=354(6.91*AGE)+PA*(9.36*WT+726*HT)
CASE STUDY
• Male:
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6’0
198#
Activity: low activity
56
• Weight in Kg
• Height in Meters
• PA= for activity level
Prevention
http://www.girlshealth.gov/bones/
Bone Densitometry
• Bone densitometry
– The measurement of bone mineral content
– Important in early detection and treatment of
osteoporosis and monitoring progression and
response to treatment
– Dual-energy X-Ray Absorptiometry (DXA) is
the most widely used technology for determining
bone mineral density
• Quantitative Ultrasongoraphy (QUS)
– Identify those persons likely to benefit from DXA testing
Unit 8 Project Section
• Discuss your clients risk of Coronary
Heart Disease
• Compare your clients current diet to the
Nutrient Composition of the Therapeutic
Lifestyle Change diet Use the
MEDFICTS dietary assessment
questionnaire (appendix E)
Questions